buyer-registration-form

Retailer Registration

ALL INFORMATION ON THIS FORM MUST BE COMPLETED and proper credentials submitted or this form will be rejected.

Retail Store Name

Store Address

Apt, Suite, Unit#

City

State/Country

Zip

Email

Is your mailing address the same as your store address above?

Yes No

Mailing Address

Mailing address Apt, Suite, Unit#

Mail City

Mail State

Mail Zip

Telephone

Cell Phone

FAX

Owner(s)/Buyer(s) Information

Owners First Name

Owners Last Name

Owners Phone Number

Owners Cell Phone Number

Owners Email

First Name Buyer #1

Last Name Buyer #1

Buyer #1 Email

Buyer #1 Cell Phone Number

Are you a

Owner Buyer

Buying responsibility for: (ex: Mens, Footwear, etc.)

First Name Buyer #2

Last Name Buyer #2

Buyer #2 Email

Buyer #2 Cell Phone Number

Are you a

Owner Buyer

Buying responsibility for: (ex: Mens, Footwear, etc.)

First Name Buyer #3

Last Name Buyer #3

Buyer #3 Email

Buyer #3 Cell Phone Number

Are you a

Owner Buyer

Buying responsibility for: (ex: Mens, Footwear, etc.)

First Name Buyer #4

Last Name Buyer #4

Buyer #4 Email

Buyer #4 Cell Phone Number

Are you a

Owner Buyer

Buying responsibility for: (ex: Mens, Footwear, etc.)

First Name Buyer #5

Last Name Buyer #5

Buyer #5 Email

Buyer #5 Cell Phone Number

Are you a

Owner Buyer

Buying responsibility for: (ex: Mens, Footwear, etc.)

CATEGORY (Check all that apply)

Other

Business credentials: First time buyers are required to scan and submit via email to michael@cobbtradeshow.com:

Current Business License or Resale Tax Certificate
Imprinted Business check/Corporate credit/debit card
TWO Recent Invoices TOTAL $500.00 PER INVOICE!

ALL CREDENTIALS MUST BE SUBMITTED FOR ENTRY CONSIDERATION. Email them to michael@cobbtradeshow.com